Features September 2019 Issue

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What You Need to Know

- Older adults are at risk of biceps tendon injuries due to natural aging of the tissues.
- To prevent biceps tendon injuries, keep your arm bent when lifting heavy objects.
- Biceps tendon injuries at the shoulder donít usually require surgery.
- Surgery is necessary for biceps tendon ruptures at the elbow.

Biceps Tendon Injury

Tendons at the shoulder and elbow may become inflamed or torn, causing pain and some loss of function.

Pain and weakness when bending your elbow or turning your palm upward may be signs of an injury to the strong fibrous tissues called tendons that attach the biceps muscle to bone.

"The function of the biceps muscle is to flex the elbow and to turn the palm up such as what you would do to open a door," says Mark Schickendantz, MD, anorthopaedic surgeon and Director of the Cleveland Clinic Sports HealthCenter.

The biceps muscle is attached by two tendons at the shoulder (proximal tendons) and by one tendon at the elbow (distal tendon). "The biceps tendons can develop tendonitis, partial tearing and can completely rupture," says Dr.Schickendantz.

Injuries to the tendons at the shoulder or elbow have different symptoms and treatments.

At the Shoulder

There are two biceps tendons at the shoulder, called the long head and short head. "The long head of the tendon is deep in the shoulder, and it passes out of the shoulder joint into a little groove at the top of the humerus bone," explains Dr. Schickendantz. This lengthy pathway makes the long head of the biceps tendon more prone to injury than the short head.

The long head of the biceps tendon can become inflamed or irritated, a painful condition called tendonitis. "Proximal biceps tendonitis causes pain along the biceps muscle in the upper part of the arm with activities that involve bending the elbow or lifting the arm overhead," he says.

Tendonitis may lead to partial tears in the proximal biceps tendon, which cause pain when you use the muscle. Partial tears can progress to a complete rupture of the tendon, causing it to detach from the bone.

"If the tendon ruptures completely, the patient would notice a bump in their upper arm at the biceps muscle called a Popeye deformity," says Dr. Schickendantz. Severe proximal biceps tendon injuries may cause muscle weakness and difficulties performing certain tasks that involve rotating the palm, such as opening ajar.

Treatment

"How you treat a proximal biceps injury depends upon the severity of the injury and the physical needs and demands of the patient," says Dr. Schickendantz. Tendonitis is usually treated with modified activities and anti-inflammatory drugs, such as ibuprofen (Advilģ, Motrinģ). Chronic biceps tendon disease that is not responding to these treatments may be treated by arthroscopic surgery.

Options include scraping away diseased tissue (debridement), cutting the tendon (tenotomy) or cutting and reattaching the tendon to a different site (tenodesis).

Surgery is offered to people with very severe tendonitis or high-grade tearing. Surgery may also be done for people who have a physically demanding job or lifestyle. "An older adult who plays sports just once in a while may never need to have surgery," says Dr. Schickendantz.

At the Elbow

The distal biceps tendon runs from the lower biceps muscle, across the elbow crease, and attaches to the radius (one of the two bones in the forearm). The most common injury of the distal biceps tendon is rupture.

"This is caused by overload of the tendon when you have your arm extended with the elbow straight and you forcefully lift something heavy," explains Dr. Schickendantz. This injury causes significant impairment to elbow function. "Distal biceps tendon ruptures tend to be surgically repaired regardless of the person's age," he says.

Are You at Risk?

According to Dr. Schickendantz, "older adults are more prone to biceps tendon injuries because of the natural aging of the tissue." Biceps tendon injuries are usually caused by damage from normal wear and tear on the joints. This is compounded through overuse of the joint, such as from certain sports or occupations. Also, pulling or lifting a heavy object with your arm straight or falling on an outstretched arm can cause a biceps tendon injury.

Taking medications that suppress the immune system for a long period of time puts you at a slightly higher risk of a biceps tendon injury. A group of antibiotics called fluoroquinolones (ciprofloxacin is an example) have been associated with increased risk of biceps tendon rupture.

"There is no cause and effect of having arthritis in the shoulder unless someone has severe inflammatory arthritis, which increases risk for tendon ruptures everywhere," explains Dr. Schickendantz.